Clinical Case Reviewer/assessor, Nhs Chc Appeals

3 weeks ago

Preston, United Kingdom NHS Lancashire and South Cumbria Integrated Care Board Full time

The post holder will have a lead role with respect to NHS Continuing Healthcare (CHC) appeals and retrospective reviews. The role will involve the review of relevant health and social care records, coordination of meetings with families/solicitors and the completion of eligibility reviews that includes outcome letters/reports.
- Provide clinical expertise for CHC Appeals, and retrospective reviews.
- Ensure the National Framework and local processes have been robustly applied within the dispute and retrospective review process, with evidence to support CHC eligibility recommendations and decision making.
- Co-ordinate and Chair both local resolution and retrospective claim meetings and provide the expert clinical CHC advice at the meetings where patients/families have disputed decisions or requested back dated reviews of eligibility.
- Attend regular clinical supervision with Line manager
- Line manage and support clinicians and administrators working in the appeal/retrospective team
- Support Line manager in representing Lancashire and South Cumbria Integrated Care Board (ICB) at local and regional meetings about CHC appeals or retrospective claims.
- Attend (to present and defend) CHC cases at NHS England's 'Independent Review Panels' on behalf of the ICB
- Support Line Manager to review CHC appeals and retrospective review processes to identify any opportunities to improve pathways as appropriate to enhance quality and effectiveness.
- Adhere to and uphold the ICB’s vision and values
- Observe the provisions of and adhere to all ICB policies and procedures
- Complete ICB Statutory and Mandatory training as required and any other training courses relevant to the post
- Abide by the ICB’s commitment that all staff will be treated with respect by management, colleagues, patients and visitors and equally staff will treat management, colleagues, patients and visitors with the same level of respect. Staff will be supported to challenge any discriminatory behaviour that may be based on differences in race, disability, language, culture, religion, sexuality, age, and gender or employment status.
- Adhere to relevant Code of Practice of Professional body (if appropriate)
- The post holder must be flexible in the duties performed and it is expected that similar duties, not specifically listed above, will be carried out as required and may be cross site.
- Provide clinical expertise for CHC Appeals, and retrospective reviews;
- Ensure the National Framework process has been robustly applied within the dispute and retrospective review process, with evidence to support CHC eligibility recommendations and decision making;
- Co-ordinate and Chair both local resolution and retrospective claim meetings and provide the expert clinical CHC advice at the meetings where patients/families have disputed decisions or requested back dated reviews of eligibility;
- Attend regular clinical supervision with Line manager
- Bring to the attention of Line manager any issues in regard to the activity and volume of assessment requests in order to safely manage workload;
- Work to timescales in line with National Framework guidance in respect of CHC disputes;
- Support Line manager in representing Lancashire and South Cumbria Integrated Care Board (ICB) at local and regional meetings about CHC appeals or retrospective claims;
- Attend with Line manager to present and defend CHC cases at NHS England's 'Independent Review Panels' on behalf of the ICB
- Support Line Manager to review CHC appeals and retrospective review processes to identify any opportunities to improve pathways as appropriate to enhance quality and effectiveness;
- Meet with patients/representatives in potentially highly contentious situations and provide responses to complex CHC disputes.
- Be expected to engage with patients and public in a meaningful way in relation to CHC appeals and retrospective reviews
- Ensure patient/families/representatives are supported and aware of the appeal process followed by the ICB in relation to CHC
- Provide timely relevant correspondence to patients/families/representatives ensuring they are kept informed of developments
- Work in partnership with the Finance Department to ensure any payment is calculated, interest is applied (if appropriate) and processed in line with ICB policies
- Support Line Manager in ensuring the relevant documentation including Health and Social care records are provided in a timely manner to NHS England as part of the independent review panel appeal process
- Attend Personal Development Review as requested by Line manage

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